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Multicenter Study
. 2021 Dec 8;25(1):421.
doi: 10.1186/s13054-021-03784-2.

Benefits and risks of noninvasive oxygenation strategy in COVID-19: a multicenter, prospective cohort study (COVID-ICU) in 137 hospitals

COVID-ICU group, for the REVA network, COVID-ICU investigators
Collaborators
Multicenter Study

Benefits and risks of noninvasive oxygenation strategy in COVID-19: a multicenter, prospective cohort study (COVID-ICU) in 137 hospitals

COVID-ICU group, for the REVA network, COVID-ICU investigators. Crit Care. .

Abstract

Rational: To evaluate the respective impact of standard oxygen, high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) on oxygenation failure rate and mortality in COVID-19 patients admitted to intensive care units (ICUs).

Methods: Multicenter, prospective cohort study (COVID-ICU) in 137 hospitals in France, Belgium, and Switzerland. Demographic, clinical, respiratory support, oxygenation failure, and survival data were collected. Oxygenation failure was defined as either intubation or death in the ICU without intubation. Variables independently associated with oxygenation failure and Day-90 mortality were assessed using multivariate logistic regression.

Results: From February 25 to May 4, 2020, 4754 patients were admitted in ICU. Of these, 1491 patients were not intubated on the day of ICU admission and received standard oxygen therapy (51%), HFNC (38%), or NIV (11%) (P < 0.001). Oxygenation failure occurred in 739 (50%) patients (678 intubation and 61 death). For standard oxygen, HFNC, and NIV, oxygenation failure rate was 49%, 48%, and 60% (P < 0.001). By multivariate analysis, HFNC (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.36-0.99, P = 0.013) but not NIV (OR 1.57, 95% CI 0.78-3.21) was associated with a reduction in oxygenation failure). Overall 90-day mortality was 21%. By multivariable analysis, HFNC was not associated with a change in mortality (OR 0.90, 95% CI 0.61-1.33), while NIV was associated with increased mortality (OR 2.75, 95% CI 1.79-4.21, P < 0.001).

Conclusion: In patients with COVID-19, HFNC was associated with a reduction in oxygenation failure without improvement in 90-day mortality, whereas NIV was associated with a higher mortality in these patients. Randomized controlled trials are needed.

Keywords: Acute respiratory distress syndrome; Acute respiratory failure; COVID-19; High-flow nasal cannula; Intubation; Mechanical ventilation; Mortality; Outcome.

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Conflict of interest statement

MS reported personal fees from Getinge, Drager, and Xenios, outside the submitted work. AD reports personal fees from Medtronic, grants, personal fees, and non-financial support from Philips, personal fees from Baxter, personal fees from Hamilton, personal fees and non-financial support from Fisher & Paykel, grants from French Ministry of Health, personal fees from Getinge, grants and personal fees from Respinor, grants and non-financial support from Lungpacer, outside the submitted work. AM reported personal fees from Faron Pharmaceuticals, Air Liquid Medical Systems, Pfizer, Resmed and Draeger and grants and personal fees from Fisher and Paykel and Covidien, outside this work. MD reported personal fees from Lungpacer. AK reported personal fees from Aspen, Aguettant, and MSD. CG reported receiving grants, personal fees, and nonfinancial support from Fisher & Paykel Healthcare and grants and nonfinancial support from ResMed outside the submitted work. JRD reported receiving travel and accommodation expenses from Fisher & Paykel Healthcare outside the submitted work. No other disclosures were reported.

Figures

Fig. 1
Fig. 1
Flow of patient screening and inclusion. COVID-19, coronavirus disease 2019; ICU, intensive care unit; HFNC, high-flow nasal cannula; NIV, noninvasive ventilation
Fig. 2
Fig. 2
Left panel: Cumulative incidence of oxygenation failure according to the oxygenation technique in patients not intubated on the day of intensive care unit admission. Right panel: Cumulative incidence of hospital mortality according to the oxygenation technique. HFNC, high-flow nasal cannula; NIV, noninvasive ventilation;
See this image and copyright information in PMC

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